Dive Brief:
- A study by the Workers Compensation Research Institutefinds "hundreds of millions of dollars" in insurance claims may shift from group health insurance carriers to workers’ compensation carriers due to the expansion of accountable care organizations (ACOs) under the Affordable Care Act (ACA).
- The authors say this case-shifting is a significant and little-discussed effect of the ACA.
- The study examines the extent to which the financial incentives facing providers and healthcare organizations, due to workers’ compensation still typically paying fee-for-service, is influencing whether a patient's injury is considered to be work-related.
Dive Insight:
Among the report's findings were that a patient covered by a capitated group health plan was 11% more likely to have a soft-tissue injury deemed work-related than a patient covered by a fee-for-service group health plan.
According to the executive summary, "as capitation becomes more common in more states, case-shifting to workers’ compensation will be expected to increase."
The authors illustrate the potential impact to workers’ compensation, noting if 3% of group health cases with soft tissue conditions such as non-specific back pain are shifted away, workers’ compensation costs in a state such as Pennsylvania could increase by nearly $100,000,000.
